A patient with leprosy develops sudden painful swelling and redness of multiple existing skin patches along with fever and arthralgia. Nerve tenderness is also noted. The most likely reaction type and immediate management is:
- A Type 2 (ENL) reaction; thalidomide 100–300 mg/day
- B Lucio's phenomenon; plasmapheresis
- C Type 1 (reversal) reaction; clofazimine loading dose
- D Type 1 (reversal) reaction; oral prednisolone 40 mg/day ✓
Explanation
Type 1 (reversal) reaction in leprosy occurs in borderline forms (BT, BB, BL) due to sudden upgrading of cell-mediated immunity, causing inflammation of existing skin lesions and acute neuritis, which may lead to nerve damage and disability. Immediate treatment with prednisolone (40–60 mg/day tapering over 6 months) is essential to prevent permanent nerve damage. Type 2 (ENL) reaction shows new erythematous tender nodules (erythema nodosum leprosum) and is managed with thalidomide or clofazimine. Lucio's phenomenon is a necrotizing vasculitis in diffuse lepromatous leprosy.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.